Healthcare Provider Details

I. General information

NPI: 1669391637
Provider Name (Legal Business Name): JAGGER STEPHENS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3143 STATE RD STE 100
LA CROSSE WI
54601-6964
US

IV. Provider business mailing address

3143 STATE RD STE 100
LA CROSSE WI
54601-6964
US

V. Phone/Fax

Practice location:
  • Phone: 608-788-0030
  • Fax: 608-788-7881
Mailing address:
  • Phone: 608-788-0030
  • Fax: 608-788-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6002285-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: